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MECHANICAL.INSPECTOR BECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCAR TION
<br />I h6by amrn hdcr I'cMlry ot nerjury rh.r I m ci.mtr fiom rhe Conmdm Licens. ttq for rlE followir8 E.sn (sa.701t.5
<br />Busincss .nd Pri,lcssion Codc) Any Cily or Cou y which ,.quircs 3 Frni ro conddcr. 8lrs. impmrc. dcmlhh or Epat any
<br />srtucruc. Itrior ro irs hsude. oho equiEs rhe srpliconr for such p.mir ro lilc a siSned slarcftnl rh,r lE or ihc is liccn*d pur$ r
<br />ro tc provisioor ofrh. Conrractor's LiBnscd ljw (ChapH 9. ConieNilg wilh Setion ?00O.f Division'l otllE Bu.incs,nd
<br />Pmf.sio$ Code) o. lnrt h tr shc t qempl rlrefrcm&d rlE hGi! lor rE illcS.d .xcq,lion. Any viohtioi of Selion ?0115 b, lny
<br />applisl for . Fmir subj€.ls thr lpplkanl lo acivilFExyofnot mElno fivc hundr.d doll&s (1500).
<br />-1,
<br />as ownfi ol rh. ImFny. or my c.rrloles wilh wa8.s rs rh.n st omp.nslhn, will do rh. sort and lhc sm.lm ir rcr
<br />inrcderl or olibEd lnr sL (s6 7014, Buri*ss and Pmfcssions codq Ttc Conracrofr Liccnsc Ltw .Lcs mr apply ro .n ovmr of
<br />lhr pmpcny whr b{irds tr irqmrts tlrcMn. ard Bho d6 sct mlk him$lf or hcrelior lhmush his D, hcr ow. cnploy4s.
<br />0rovidcd rhd skh im!remnts @ mr i cndcd oroltrcn fo. qL. li h.wB. fi. huildiq or nryoErnrn sB eithin oft ru,
<br />ot smpLrion. rhe Owtur BuiBs vill hlE rlr hrdcn of Fovin8 fid hc or nr di, or hoiu or ir{ew lhe pol{n, ht llE pnpos of
<br />-1,
<br />!s own{ oa r hc nmFrrr. 0m crclusilelr conrrucr ins wirh ,ilrnsd conr.lcrod ro coosrrud rhe F)jc.r (Scc 7M, Bu\inc$
<br />nd PrfdsiD cod.: Thc contrdols Liccnsc tjw dDr* nor q,tly ro on oqncr ofprcpcirywho build\ or imtrclcs rh.icon.
<br />and who.onrB-tsnrsuctF.ixl$wirh!Coorffkn(9lilrn*dp!^unrrorh.ConkB.u\Liccn*trw,.
<br />-l
<br />rm cxcnrpl u.d.r Se on- B. & P.C. for Inh rcasn
<br />UOBf,ES OMPIISAIION
<br />oDctASArxld
<br />I hcrcby amrm undcr pcMlly of lcrjury otu of rhc followin8 dccl,r.tiotrs:
<br />-l
<br />hrvc .rn *ill minkin ! CcnifEd. of Cone ro Sclf'ln$rc ftr qorten .ofirnsarion. ui prlvitn for by SEiio. 3?00 of $.
<br />ljtE. Codc.lo.thc pcrformR ofth. srk for vnth tn Fnjr is icaud.
<br />_l havc and *ill minlain qorke$ conn nsaion iBuhft.. ,s Eqltcd by Serion 3700 ot thc trb6r C.nc. fo. lhc psfolrMa of
<br />th. M* fo' *hkhrhtDcmi i. irnr.d Mrwo,lrss Ommnrdiun incurmc Mi(r,n polFy numb.r m:
<br />cet, .5/16 D-/
<br />I ccniliihat in rhc n rlormmc ofrhc work for whi.h rhi p.rmn i. ksu.d. I shall nol cnlloy lny pcron in any ronner
<br />$ os lo bcom subict to lh€ uorkcn'compcn$lion bws of Cllifomia. md lgrc thlt it I slhuld tEtom sxbi{ ro rlF
<br />woltal comFnsati,tr ,,ovisions o{Sccrion 1700 ofrhc L3hx tue.l shau- fonh*irh coq)ly *nh$.s pmvbions
<br />WARNINGT Fdilurc b $.urc wor*crs ompcN0lion ..vcn8c h xnlawful. !trd shall subict on crryloycr to dnind Fidhis !.d
<br />.ivil rincr uti r, onc hundrcd lhousdnd dollaA ($addilion lo rhc cosr ofconrpcndion. drm8cs 3s lrovided tor rhc
<br />Sr.ri(m 1076.lrhr l-rhn Cixl.. iIrrrr rtrd
<br />"",,.
<br />'7-7o-l I
<br />uuilsDllc(JNl&tl:Iaa
<br />IECLAEAUAN
<br />I h.rby nflirmrnd$ pcidryoltrrjurt rh[ I m li.ci*d undcr pn,visn olChirlcr9(lannnrncir8silhSccli,)n7(xX)rofDivi\n,n]
<br />ol lhc Bu\ircs\rnd Pm,cssion\Codc, rtol nrr licco\r i\ i,r lnllr{nftaidrffmr
<br />7->o-1tr
<br />CqNSIAIIGIIANI&DAC.ACENIA
<br />I lEEby aflirmrnd.r FtultyofFilry$d rhd. h !onlltoctbi hndingogdcy fo.rhc Frf.'!rrl.E 6fuc rc fo. vhih this Fnl b
<br />issd (Sm. 309?. Civ. C.).
<br />Ltruc NLDEcrin roN
<br />I L*(ny nnnru .r !.rJlr, ol r^-rrury otrc.l'rh. n)llo*nr8n..l iri, r(
<br />I)rnrn ri,,n l'$n ts \hc{o\ N.riri.Ji,r lrcdcrrl k.guhri,nr ( Iirlc.lo. I'xn6)
<br />Rcquirctl lrfi cr of Nolifi corioi
<br />Icdilyrh,' rh. fcdcral Eguhlions rcBeding aslf,r'os rcnxrvtrl m nor oflrlic.hle ro lhis pmj.rl
<br />l.cnify rhdr I hav. rud i.0rion uld 3rar. rh.! rh. obov. nr6nMion is corer. I !E d to mry)ly snh aI Ciry and Colnry
<br />ordi'rncc\ rdd Srar.l-rtrs h.rcby *rhuria rcpEsnr.tivcs ollhn Cityand Counryh.nrc. upon rh.
<br />nh.vc nriridrd pmNny lnr
<br />Atpli.,m or AScnr Si8nar J, 7-'za-ttr
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />Misc. Equipment
<br />Duct Work
<br />Pre-lnsulation
<br />lnsulation
<br />Smoke Detectors lnstalled
<br />Rough Ductwork
<br />Vents
<br />Toilet Room / Clothes Dryer
<br />Residential Range
<br />Other
<br />Hood
<br />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openings
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.
<br />Final Test
<br />Meter Release
<br />Notes, Remarks, Etc
<br />6r'4 {
<br />lnstallation
<br />FINAL
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